eQHealth Blog

The Medicare Access and CHIP Reauthorization Act (MACRA) is bipartisan legislation signed into law April 2015. Title I of MACRA is designed to accomplish several notable goals including providing new methods to incentify the shift from volume to value-based care.
Key Goals of MACRA
The Sustainable Growth Rate (SGR) Formula was repealed.
Numerous quality programs were streamlined into one called the Merit-based Incentive Payments System (MIPS).
Provided bonus payments for participation in eligible alternative payment model...

In 2015, when CMS began the Chronic Care Management Program, CPT Code 99490, according to Medicare claims data, only about 275,000 unique Medicare beneficiaries received Chronic Care Management (CCM) services (CPT Code 99490) an average of 3 times each, totaling $37 million in allowable charges. Unfortunately, those early participants accounted for less than ~1% of those Medicare beneficiaries that actually were potentially qualified to participate in the CCM Program. So, ~99% of the beneficiary market was still potentially avai...

The population health management (PHM) industry is still in its adolescence, but further evolution is necessary and inevitable to take care delivery to the next level. By now, most have a sense of the value PHM can add and understand the macro steps needed for a successful population health initiative. The industry is good at identifying the sick in our populations and even predicting who will be sick in the future. The market is also good at developing guidelines and treatment plans to help manage chronic disease.
Where the i...

According to Heraclitus, a Greek philosopher, “change is the only constant in life”. While 2017 hardly represents a lifetime, this will be a year of profound change in healthcare. Look all around, the winds of change are blowing. We have surveyed the landscape and here a few of the topics and observations that captured our attention.
The Healthcare Law of the Land – Accountable Care Act (ACA) or Obamacare, whatever your preferred name for the current healthcare law, there will be change. In a recent report, NPR noted that t...

On the road to value-based care, providers, payers, the self-insured and other risk-bearing entities invest in care coordination programs to improve patient or member care. The good news is that often times, the care coordination programs supported by a robust technology platform utilizes predictive modeling algorithms to identify risk profiles for program participants and track and report patient/members interactions that are implemented by skilled care managers. The bad news, and what is more problematic, is that it can be difficult to quanti...

FQHCs and RHCs Are Now Able to Bill for CCM Services
When CMS introduced the opportunity for providers to bill for CPT code 99490 in January 2015, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) were excluded from participating. However, beginning January 2016, FQHCs and RHCs may now participate in the program and receive an additional payment from CMS for the costs of services that are not already captured in the RHC all inclusive rate or the FQHC prospective payment system for chronic care management services to ...

HIMSS 2016 was a whirlwind of activity, from the opening session to the closing remarks. Not surprisingly, Las Vegas as the host city only added to the usual excitement. With conference activities sprinkled among five levels in the Sands Expo Center, the show was a little tricky to navigate; on more than one occasion what seemed like a brief walk between venues took much more time than expected. But, the real highlights were associated with the hot topics at the show. We’ll highlight three in this blog.
Population Health Management...

New healthcare trends in 2016 and in years down the road will affect value-based care and population health management. The healthcare industry continues to evolve, and comes with both good and bad news regarding healthcare costs. A reminder, healthcare costs as a percent of Gross Domestic Product have hovered around 17.5 percent for the last few years. The bad news: costs as a percentage of GDP are projected to increase and reach 19.6 percent by 2024. Conversely, the good news is that the growth in healthcare costs are not due to simple inflat...

Whether you are a care coordinator, caregiver or a family member of someone who is getting up in age, chances are you know someone with chronic conditions. During the holidays, many factors affect the people around us, especially those with chronic health conditions. Whether it's the holiday blues, traveling out of town or trying to manage diet restrictions and other self-care measures, these are all things that need to be monitored with extra care over the holidays. Here are some tips on navigating chronic conditions during the holiday season....

In 2012, about half of all Americans suffered from some sort of chronic disease, such as diabetes, heart disease, or lung disease. In addition to this excessive amount of people suffering, the health care system is suffering as well. $3 out of $4 in health care are spent on chronic disease. Reducing and better managing chronic diseases has the potential to improve the lifestyle of millions of adults in the US while also cutting costs for healthcare providers.
In recent years, the growing epidemic of chronic disease in America has not g...